Research, education aim to reduce skin cancer cases in farmers and ranchers

For Kathryn Stensgard, skin cancer started as a family issue. Preventing it has become a personal passion.

She has seen too much of it.

On her father’s side of the family, five of her six relatives dealt with skin cancer — including her father. Growing up on a family-run small grains and registered Gelbvieh cattle operation south of Mandan, N.D., in Morton County, she saw it affect residents in the local community.

With those personal experiences in mind, Stensgard wants to send an important message: Skin cancer is the most common cancer in the U.S., affecting more than 2 million Americans per year, but it also is the most treatable, especially when detected early.

She wants farmers and ranchers — a group among whom skin cancer rates are statistically higher — to take special notice.

“These people (farmers and ranchers) spend so much time outdoors, and there’s no way around that,” Stensgard says.

Though she can’t change the nature of farm and ranch work, she is hoping to change sun protection habits and reverse a concerning trend: Skin cancer cases are on the rise, and farmers and ranchers remain at high risk.

Skin cancer is prevalent among farmers and ranchers largely because of the nature of their job — much of their occupation involves working outdoors, oftentimes in long stretches exposed to the sun. Rural residents also are less likely than urban dwellers to use sunscreen and are more likely to be diagnosed when the cancer is at a more advanced state, Stensgard says.

Stensgard is using recent research she’s done as a doctor of nursing practice student at North Dakota State University in Fargo to back it up those facts.

Getting started

“I think the biggest thing was seeing it so prevalent in my community,” Stensgard says of the motivation for her research.

She hopes her study serves as an additional resource for skin cancer education and prevention, a means of “encouragement for people to protect themselves.” The goal, she says, is to educate people and help them “take better care of themselves,” ultimately reducing the number of cases. Another objective is that the findings of the study can be utilized to improve the practices of nurse practitioners at family practice clinics.

“The more that we can educate people now, hopefully we can get the incidence to decrease,” she says.

Stensgard used a speaking engagement at the Morton County Soil Conservation Conference in Mandan, N.D. in spring 2012 to start the research. There, she surveyed the sun protection practices of 104 people attending the conference, most of whom were involved in farming and ranching.

The surveyed group was 70 percent men and 30 percent women. Thirty-three percent were ranchers, and 21 percent did both farming and ranching. Thirty-nine percent were 41 to 60 and 28 percent were 25 to 40. All were Caucasian, and most were considered to have a fair skin type.

Of the surveyed group, 55 percent said their skin tans easily after an initial sunburn. Twenty-one percent said their skin burns easily and tans with difficulty. Eleven percent had a personal history of skin cancer and 23 percent had a history of skin cancer in their family.

A closer look at the numbers:

• Of the 104 people surveyed, 36 percent said they don’t use sunscreen at all, and 50 percent said they rarely or never include it as part of their daily routine.

• People in the 25 to 40 age group reported the most frequent sunscreen use, while people 61 to 80 were least likely to use it, according to the survey.

• People with a personal or family history of skin cancer were more likely to use sunscreen, according to the survey.

• Of the 104 people taking the survey, 51 said they reapply sunscreen once a day, 34 said they apply it immediately before going outside and 33 said they apply sunscreen within 20 minutes of being outside.

• Seventy-four percent said they hadn't received formal instruction from a health care provider on the use of sunscreen.

• Most in the surveyed group noted using other forms of sun protection, such as sunglasses, hats or additional clothing.

Stensgard’s research was two-fold. After the first survey, she gave a slide presentation about skin cancer and distributed other educational materials including brochures. Participants were surveyed a second time, with questions evaluating their intent to change their prevention practices.

The presentation made a difference: 95 percent said they had a better understanding of skin cancer and sun protection measures. Overall, participants were 3.47 times more likely to use sunscreen, and 88 percent said they were more likely to complete self skin examinations.

Some highlights from the presentation:

• In North Dakota, there was an average of 162 cases of melanoma from 2005 to 2009.

• Men are more likely to develop non-melanoma and melanoma skin cancers. The number of cases in males increased from 74 in 2005 to 99 in 2009.

• The risk of developing melanoma is 10 times greater for Caucasians than African Americans.

Stensgard will graduate in from NDSU in May as a nurse practitioner. Her co-investigator on the study was Norma Kiser-Larson, Stensgard’s academic adviser and an associate professor of nursing at NDSU. Stensgard is working on publishing her research in a journal.

She hopes her research results in better preventative habits.

“I want the knowledge of skin cancer and healthy sun protection behaviors to increase for farmers and ranchers across the state of North Dakota, and any outdoor workers for that matter,” Stensgard says. “That’s the primary goal.”

Staying protected

For a person younger than 20, a single blistering and peeling sunburn doubles his or her lifetime risk of developing melanoma. Three or more severe sunburns increases the risk of melanoma by five times.

“Once you’ve had a burn, the damage has been done,” says Kathryn Stensgard, doctor of nursing practice student at North Dakota State University in Fargo. “Even if you’ve had a sunburn that has healed, the damage to the underlying cells has not.”

Damage from sun exposure is a risk in winter, too. Though the sun often is shielded by cloud cover and its rays aren’t as strong, snow can reflect sunlight, increasing sunburn risk.

“There’s definitely a year-round need for sun protection,” Stensgard says.

Early detection and diagnosis of melanoma are the most critical factors in an improved survival rate. The skin cancer risk is high for farmers and ranchers, whose work typically involves long periods outdoors exposed to the sun and its potentially harmful ultraviolet rays.

Fortunately, skin cancer is preventable and treatable — especially when detected early. There are several ways farmers and ranchers can reduce their risk:

• Avoid being outdoors between 10 a.m. and 4 p.m.

• Use sunscreen with a sun protection factor (SPF) rating of 30 or higher. Lip balms have SPF ratings, too. Use SPF 30 or higher.

• Apply sunscreen 30 minutes before going outdoors and reapply it often — every two hours if sweating.

• When using sunscreen, pay special attention to the face, ears, hands, arms and areas not covered by clothing.

• Wear a wide-brimmed hat and sunglasses.

• Apply sunscreen before insect repellant.

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